Provider Demographics
NPI:1114519790
Name:PINKSTON, KATHLEEN ANN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:PINKSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 HIDDEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-8409
Mailing Address - Country:US
Mailing Address - Phone:208-830-4531
Mailing Address - Fax:
Practice Address - Street 1:135 E MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4892
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-438261041C0700X
NCC0162791041C0700X
SC162381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical